Hornung Alexander L, Baker James D, Mallow G Michael, Sayari Arash J, Albert Hanne B, Tkachev Alexander, An Howard S, Samartzis Dino
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago.
The Modic Clinic, Odense, Denmark.
JBJS Rev. 2023 Jan 4;11(1). doi: e22.00148. eCollection 2023 Jan 1.
Resorption after lumbar disk herniation is a common yet unpredictable finding. It is hypothesized that nearly 70% of lumbar herniated nucleus pulposus (HNP) undergo the resorption to a significant degree after acute herniation, which has led to nonoperative management before surgical planning.
This narrative review on the literature from 4 databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Cochrane) examines historical and recent advancements related to disk resorption. Studies were appraised for their description of the predictive factor (e.g., imaging or morphologic factors), pathophysiology, and treatment recommendations.
We reviewed 68 articles considering the possibility of resorption of lumbar HNP. Recent literature has proposed various mechanisms (inflammation and neovascularization, dehydration, and mechanical traction) of lumbar disk resorption; however, consensus has yet to be established. Current factors that increase the likelihood of resorption include the initial size of the herniation, sequestration, percentage of rim enhancement on initial gadolinium-based magnetic resonance imaging (MRI), composition of inflammatory mediators, and involvement of the posterior longitudinal ligament.
Heterogeneity in imaging and morphologic factors has led to uncertainty in the identification of which lumbar herniations will resorb. Current factors that increase the likelihood of disk resorption include the initial size of the herniation, sequestration, percentage of rim enhancement on initial MRI, composition of cellular and inflammatory mediators present, and involvement of the posterior longitudinal ligament. This review article highlights the role of disk resorption after herniation without surgical intervention and questions the role of traditional noninflammatory medications after acute herniation. Further research is warranted to refine the ideal patient profile for disk resorption to ultimately avoid unnecessary treatment, thus individualizing patient care.
腰椎间盘突出症后的吸收是一个常见但不可预测的现象。据推测，近70%的腰椎间盘突出症（HNP）在急性突出后会有显著程度的吸收，这导致在手术规划前采用非手术治疗。
本叙述性综述对4个数据库（MEDLINE、护理及相关健康文献累积索引、Scopus和Cochrane）中的文献进行了研究，探讨了与椎间盘吸收相关的历史和最新进展。对各项研究的预测因素（如影像学或形态学因素）、病理生理学及治疗建议的描述进行了评估。
我们查阅了68篇考虑腰椎HNP吸收可能性的文章。近期文献提出了腰椎间盘吸收的多种机制（炎症与新生血管形成、脱水及机械牵引）；然而，尚未达成共识。目前增加吸收可能性的因素包括突出的初始大小、游离、初始钆基磁共振成像（MRI）上边缘强化的百分比、炎症介质的组成以及后纵韧带的受累情况。
影像学和形态学因素的异质性导致在确定哪些腰椎间盘突出症会吸收方面存在不确定性。目前增加椎间盘吸收可能性的因素包括突出的初始大小、游离、初始MRI上边缘强化的百分比、存在的细胞和炎症介质的组成以及后纵韧带的受累情况。这篇综述文章强调了在无手术干预情况下椎间盘突出后吸收的作用，并对急性突出后传统非抗炎药物的作用提出了质疑。有必要进行进一步研究以完善椎间盘吸收的理想患者特征，从而最终避免不必要的治疗，实现患者护理的个体化。
